The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Abstract

The nationwide Dutch Hip Fracture Audit (DHFA) is initiated to improve the quality of hip fracture care by providing insight into the actual quality of hip fracture care in daily practice. The baseline results demonstrate variance in practice, providing potential starting points to improve the quality of care.

Purpose: The aim of this study is to describe the development and initiation of the DHFA. The secondary aim is to describe the hip fracture care in the Netherlands at the start of the audit and to assess whether there are differences in processes at baseline between hospitals.

Methods: Eighty-one hospitals were asked to register their consecutive hip fracture patients since April 2016. In 2017, the first full calendar year, the case ascertainment was determined at audit level. Three quality indicators were used to describe and assess the care process at audit and hospital level: the proportion of completed variables at discharge and at 3 months after operation, time to surgery and orthogeriatric management.

Results: Sixty (74%) hospitals documented 14,274 patients in the DHFA by December 2017. In 2017, the case ascertainment was 58% and the average proportion of completed variables was 77%: 91% at discharge and 30% at 3 months. The median time to operation was 18 h (IQR 7-23) for American Society of Anesthesiologists score (ASA) 1-2 patients and 21 h (IQR 13-27) for ASA 3-4 patients. Of patients aged 70 years and older, 78% received orthogeriatric management. At hospital level, all three indicators showed significant practice variance.

Conclusion: Not all hospitals participate in the DHFA, and the data gathering process needs to be further optimized. However, the baseline results demonstrate an apparent variance in hip fracture practice between hospitals in the Netherlands, providing potential starting points to improve the quality of hip fracture care.

Keywords: Audit; Benchmark; Dutch Hip Fracture Audit; Hip fracture; Quality indicators.

Fig. 1

a Funnel plot of the proportion of variables (variables included date of birth, gender, type of fracture, type of treatment, ASA score, date and time of arrival at emergency department, date and time of surgery, consultation of geriatrician, date of discharge, type of anaesthesia, complications, Katz Index of Independence in Activities of Daily Living at admission, mobility score at admission, living situation before admission, reoperations, 3-month Katz Index of Independence in Activities of Daily Living at admission, 3-month mobility score, 3-month living situation) completed per hospital in the Dutch Hip Fracture Audit in 2017. b The percentage of ASA 1/2 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 18 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. c The percentage of ASA 3/4 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 21 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. d Orthogeriatric management during admission of patients 70 years and older with a surgically treated hip fracture.

Fig. 1

a Funnel plot of the proportion of variables (variables included date of birth, gender, type of fracture, type of treatment, ASA score, date and time of arrival at emergency department, date and time of surgery, consultation of geriatrician, date of discharge, type of anaesthesia, complications, Katz Index of Independence in Activities of Daily Living at admission, mobility score at admission, living situation before admission, reoperations, 3-month Katz Index of Independence in Activities of Daily Living at admission, 3-month mobility score, 3-month living situation) completed per hospital in the Dutch Hip Fracture Audit in 2017. b The percentage of ASA 1/2 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 18 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. c The percentage of ASA 3/4 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 21 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. d Orthogeriatric management during admission of patients 70 years and older with a surgically treated hip fracture.

Fig. 1

a Funnel plot of the proportion of variables (variables included date of birth, gender, type of fracture, type of treatment, ASA score, date and time of arrival at emergency department, date and time of surgery, consultation of geriatrician, date of discharge, type of anaesthesia, complications, Katz Index of Independence in Activities of Daily Living at admission, mobility score at admission, living situation before admission, reoperations, 3-month Katz Index of Independence in Activities of Daily Living at admission, 3-month mobility score, 3-month living situation) completed per hospital in the Dutch Hip Fracture Audit in 2017. b The percentage of ASA 1/2 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 18 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. c The percentage of ASA 3/4 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 21 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. d Orthogeriatric management during admission of patients 70 years and older with a surgically treated hip fracture.

Fig. 1

a Funnel plot of the proportion of variables (variables included date of birth, gender, type of fracture, type of treatment, ASA score, date and time of arrival at emergency department, date and time of surgery, consultation of geriatrician, date of discharge, type of anaesthesia, complications, Katz Index of Independence in Activities of Daily Living at admission, mobility score at admission, living situation before admission, reoperations, 3-month Katz Index of Independence in Activities of Daily Living at admission, 3-month mobility score, 3-month living situation) completed per hospital in the Dutch Hip Fracture Audit in 2017. b The percentage of ASA 1/2 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 18 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. c The percentage of ASA 3/4 patients operated within the nationwide median time difference in hours between admission and start of operation per hospital in 2017. The horizontal line represents the mean proportion of all patients who were operated within the median time of 21 h. Each dot represents the proportion of patients in a specific hospital who were operated within the median time. d Orthogeriatric management during admission of patients 70 years and older with a surgically treated hip fracture.